Uniform Certification Application-annotated
B. Additional Owner Information
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| B. Additional Owner Information (1) Describe the familial relationship of this owner to each other owner of your firm and employees. (2) Indicate whether this owner performs a management or supervisory function for any other business. If you checked Yes state the name of the other business and this owner’s function/title held in that business. (3) (a) Check the appropriate box that indicates whether this owner owns or works for any other firms) that has any relationship with your firm. If you checked Yes identify the name of the other business, the nature of the business relationship, and the owner’s function at the firm. b) If the owner works for any other firm, nonprofit organization, or is engaged in any other activity more than 10 hours per week, please identify this activity. (4) (a) Provide the personal net worth of the owner applying for certification in the space provided. Complete and attach the accompanying Personal Net Worth Statement for DBE/ACDBE Program Eligibility with your application. Note, complete this section and accompanying statement only for each owner applying for DBE qualification (i.e., for each owner claiming to be socially and economically disadvantaged. b) Check the appropriate box that indicates whether any trust has been created for the benefit of the disadvantaged owners. If you answered Yes you maybe asked to provide a copy of the trust instrument. (5) Check the appropriate to indicate whether any of your immediate family members, managers, or employees, own, manage, or are associated with another company. Immediate family member is defined in 49 C.F.R. §26.5. If you answered Yes provide the name of each person, your relationship to them, the name of the company, the type of business, and whether they own or manage the company. Download 1.19 Mb. Share with your friends:
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